Yesterday, a thirty-nine-year-old, never-married, Army psychiatrist with expertise in disaster and preventive psychiatry allegedly gunned down thirteen men and women, wounding thirty-eight. The murderous incident took place at Fort Hood, a military base in Texas where soldiers were being prepared for deployment to Iraq and Afghanistan. Though the suspected perpetrator, Major Nidal Malik Hasan had initially been reported killed by military police, we now know he was seriously wounded, is currently in a coma, but expected to survive. What could possibly possess an apparently polite, pleasant, quiet, reserved, compassionate, empathetic, forgiving and deeply religious psychiatrist to commit this incredibly evil deed?
Dr. Hasan is a life-long and devout Muslim with Palestinian roots. But he was born in America. He received his extensive medical education--approximately four years of medical school for his M.D. and another four of psychiatric training--compliments of Uncle Sam, who, in return, expected Hasan to serve his country in whatever manner the military saw fit. But there may have been a religious, moral and political conflict of interest for Dr. Hasan regarding present American policy in the Middle East, specifically the wars in Iraq and Afghanistan. He allegedly had been vociferous to some over the years in his denouncement of the "war on terror,"claiming it was tantamount to a war against Islam. It seems he had been hoping that with his election, President Obama would change course, and immediately withdraw our troops. Very recently, he apparently learned that he would soon be deployed for service as a "combat stress counselor" to Afghanistan, something he evidently objected to violently. His imminent deployment appears to be what finally triggered this furious ticking time bomb.
Hasan regularly attended daily prayers, sometimes in traditional Muslim attire. He appears, based on his suspected internet postings, to have been extremely sympathetic to Islamic suicide-bombers, evidently perceiving them as freedom-fighting martyrs heroically protecting their countrymen and fellow Muslims. These postings attracted the attention of federal law enforcement officials about six months ago. Ever since 9-11, Hasan apparently felt he had been unfairly targeted and harassed by his military colleagues regarding his religion and ethnicity. He was aggressively attempting to arrange a discharge from the Army, hiring an attorney and offering to repay the considerable cost of his eight-year medical education. He must have wanted out badly. But his bid to prematurely terminate his contractual obligation with the U.S. government had gone nowhere. This presumably frustrated Hasan immensely. As did his reportedly unsuccessful efforts to find a Muslim wife even more religiously devout than he is. (See my prior posting.)
As an Army psychiatrist, Dr. Hasan had been working intensively with soldiers suffering from post-traumatic stress disorder. PTSD--an anxiety disorder resulting from being exposed to actual or threatened death or serious injury to self or others--is a severely debilitating syndrome that can include symptoms of "flashbacks," nightmares, avoidant behavior, social withdrawal, depression, hypervigilance, irritability and outbursts of anger or rage. (See my prior post on trauma.) During his internship at Walter Reed Army Medical Center, there are reports that Hasan had serious problems dealing with his patients, problems significant enough to require personal psychotherapy and extra clinical supervision, culminating in a poor performance evaluation by his superiors. Being a mental health professional specializing in PTSD is stressful. Stress can be contagious, which is why psychotherapists need to take extra care regarding their own mental health.
Had Dr. Hasan himself been emotionally traumatized vicariously and ethically conflicted by hearing daily the grotesque horror stories of war from his fellow soldiers? By constantly being told about his fellow Muslims and Army brethren slaughtering and maiming each other--and sometimes innocent civilians--for their countries? This could result in a form of what we call countertransference: the psychotherapist's personal reactions to his or her patients and their particular presenting problems. Countertransference is a common phenomenon in mental health professionals, an occupational hazard, and must be carefully monitored. When it begins to become disturbing for the psychotherapist, impairing his or her objectivity and interfering with the treatment process, it becomes crucial to address it in supervision, consultation and/or one's own personal therapy. If the countertransference cannot be resolved in relatively short order, or at least kept in check, psychotherapists must ethically recuse themselves from such cases and refer the patient elsewhere. This begs the question: Should Dr. Hasan, given his apparently passionate religious and political beliefs, have been working with such patients in the first place?
From a forensic perspective, there is certainly far too little information available at this time to come to any meaningful conclusions regarding such a defendant's mental status. And it is improper to do so without having conducted a formal forensic evaluation. But determining his state of mind at the time of this crime and prior to it will prove crucial to his legal case. As a forensic criminal psychologist, here are some of the questions I would be asking myself if appointed by the court to evaluate such a defendant: Was the defendant clinically depressed, possibly to the point of paranoid psychosis? Could there have been any kind of substance abuse or intoxication involved? Was he in treatment and taking any psychiatric medications? Is there an underlying personality disorder? Were these shootings a tragic, impulsive manifestation of a manic or hypomanic episode, indicating the possible presence of bipolar disorder? Or, was this the hateful, calculating, vengeful act of a profoundly angry, frustrated, resentful and embittered--mad but not psychotic--person? (See my previous posts on post-traumatic embitterment disorder.)
Was Dr. Hasan a suicidal individual, who, like so many mass murderers, chose to die--very much like a suicide-bomber--taking as many victims with him as possible? Psychiatrists as a group have a notoriously high rate of suicides, though suicide rates in Muslim populations are exceedingly low. The notion that Hasan had become actively suicidal is supported by unconfirmed reports today that he advised his landlord two weeks ago that he would be leaving his apartment on the day of the shooting--despite the fact that he was not likely to actually be physically deployed for another few months. Hasan also is said to have given away his belongings, furniture, food, cleaned out his apartment, and said goodbye to friends just prior to the massacre, handing some of them copies of the Koran. Unless he was convinced he was leaving the country in the immediate future, such preparatory behavior could be interpreted as a prelude to suicide. Or, in this case, premeditated homicide-suicide. Hasan may have hoped to have time to take his own life after his murder spree, or be taken out by police. So-called suicide by cop.
But this raises the question as to whether such a defendant, if guilty, was suicidally despondent or more angry, resentful and bitter. (See my prior posts on anger disorder.) Angry, resentful and bitter enough to kill and to die for his fanatical cause. Was Hasan's presumed attack on U.S. troops primarily a political statement? What he intended to be a revolutionary call to arms to American Muslims? Quite possibly so. The FBI is presently investigating this bloodbath as a possible terrorist act. A suicide-bombing using guns instead of explosives. There are unconfirmed statements by witnesses that Hasan had at times angrily urged Muslims to violently "rise up" against Americans, and that at the chaotic scene of the shootings was heard to say "God is great" in Arabic. But until we have more information either medically, circumstantially or from the defendant himself--who evidently has no previous history of violent behavior--Hasan's hypothetical motivations for this atrocious evil deed remain ambiguous, suspicious, and somewhat mysterious.